We are the Association for Child and Adolescent Mental Health or ACAMH for short. And this is ACAMH Learn. Hello and welcome to today's session. I'm Dr. Asha Patel, clinical psychologist and founder of Innovating Minds. Now, as a clinical psychologist, my background was working in forensic mental health services. So I worked in medium secure mental health services and prisons and supported individuals across the lifespan. And I founded Innovating Minds 10 years ago to support children and young people access early help, and particularly, early trauma-informed help. My work in the mental health sector, in the forensic mental health services. I saw that adults were affected in their childhood. They experienced childhood trauma and were not able to access the early help and support that they needed by the adults around them. So I'm here today to support and share my insights with you, to look at a trauma-informed approach and how we can support children and young people affected by domestic abuse? Now, throughout this presentation, I'll be sharing some insights regarding understanding the impact of domestic abuse on children and young people, but also how you as a practitioner, you in your role, it might be even in academia, it might be frontline practise, it might be in commissioning, it might be as a team leader, how you can embed trauma-informed principles to supporting children and young people affected by domestic abuse, but also supporting those that are supporting the children and young people and families. So throughout this presentation, do look after yourself. If anything feels uncomfortable, pay attention to your body and what your body is telling you. Step away and come back to it to if you feel that you're able to do so. Now, you can also download the presentation using this QR code. So if you are interested in finding out more and accessing the slides, please use this QR code to be able to access that. Now, the aims of this presentation is to really help to develop and deepen your knowledge and understanding of domestic abuse and its impact on children and young people. Children are now seen as victims of domestic abuse in their own right. Previously, we said that children were witnesses of domestic abuse, and we know that's no longer the case. So with the implementation of the Domestic Abuse Bill and recognising children as victims in their own right, it's also really important that children are able to access help and support for themselves. So it's really key for us to think about, well, what is the impact of domestic abuse on children and young people, and how does that present? How does that show up? And what can we do as the adults that are supporting the children and young people? Now equally as important, it's also important to think about the evidence base around trauma-informed programmes to support children, young people affected by domestic abuse. And I'll be sharing the evidence base around the Healing Together Programme that Innovating Minds has delivered, and it's used nationwide to support children and young people access help on a one to one and group basis. Now, understanding the evidence base is really critical because what we do want to encourage is for frontline practitioners to be using evidence-based resources and practises to enable children to be able to access the help and support that they need. Now, if we think about domestic abuse and what is the impact, now we have to see it as a whole being experience, and we're going to take from a trauma-informed approach on this. Now, when we think about trauma-informed practise, it's become quite a buzzword. And it's really important that we think about it as a way of being. And it's a way of being, which means that actually it's not just a switch that we can flick on and off. So for you as a frontline practitioner, for you as maybe as a researcher, it's really think about how do you integrate trauma-informed practise into your day to day? How does it become your way of being, so that you start to look at things and start to behave in a manner that reflects trauma-informed practise and principles? Now, when we think about domestic abuse and the impact on children and young people, we have to see it that actually, the experience of domestic abuse is absorbed. It is felt for that child, for that young person. The unpredictability, the tension that's created within the household, the stress response that they're experiencing. Their nervous system will automatically be recording all of this and holding on to any sensory and emotional experiences that they're experiencing. And their body will be recording this and storing this information to support them in the future to survive. So it's information that the body is storing to help them to survive and to prepare for what may be coming again for their experiences. So all this is happening without them realising. So constantly, their body is scanning for information, and it's stored as a sensory memory. Now, we often think that actually, if we get children to talk about their experiences, talk about and relive their experience of domestic abuse, that will help them to process it. But actually, what we know is actually, that retraumatizes that child, and it retraumatizes their body, and their nervous system goes through that experience again. So to be able to support children and young people to be able to process the trauma that they've experienced through domestic abuse, we need to work with their nervous system. We need to think about their physical experiences that they're experiencing. And how do we allow them to feel the feelings that they're feeling and to be able to process them, so they can process the trauma that they're experiencing? Now, we have to then think about, well, how can we do this? So us, as the adult, as the adult that's there to support them, it's us as the adults that may be influencing research, influencing policy and practise. We really have to think about what we can do with the child as opposed to doing something to them. And that comes from us as the adult. We've been able to hold that safe space, be that safe, grounded adult, so they can borrow your nervous system, so that they can experience moments of co-regulation that helps them to feel safe in that moment, to be in a place, to be able to learn, to be able to process the feelings that they're feeling for their body, to feel safe from a sensory experience and the nervous system to be able to feel safe, and feel calm, and feel regulated. So we have to really think about domestic abuse as being that whole being experience. And often, it's us as adults that start to categorise domestic abuse in hierarchies. So was a child in the household when domestic abuse was taking place? What form of domestic abuse was it? If it's, for example, physical abuse as opposed to emotional abuse, we adults might say, well, actually, physical abuse is a lot worse than emotional abuse. But that is not our role to start putting types of domestic abuse and people's experiences of domestic abuse in a hierarchy. It's their experience that matters. How they're processing it will be really important for us to remember when we're supporting children and young people. Particularly because what will happen is the trauma will manifest, and it may manifest in coming out as behaviour difficulties. And you might see, actually, that this young person, it might be in their education, it might be at home, it might be that they're struggling with developing relationships and forming relationships and keeping relationships, that all this is affected. So we might get focused on the behaviour, but what we want to do is look around, actually, what is that behaviour communicating? What has this child experienced? That means that they're behaving in a way to support their survival. So it comes a form of a safety survival mechanism. And what are they communicating in their behaviour? They're not communicating that they need attention. They're communicating that they're help-seeking. They need help. Communicating that they need to connect with us as the adult. Domestic abuse could have happened at any form of that child's life, and they're likely to have experienced domestic abuse when they've been growing up. It might have been from being a baby. It might have been from when they were still in the womb, that their mum was experiencing domestic abuse. But often, it is minimised. And generally as well, it might be that a parent carer has not made the links, that this child has been a victim of domestic abuse and that they've experienced domestic abuse. Or it could be the child that's not made the links and recognise actually that they are a victim of domestic abuse because this could be their norm. It could have been their childhood norm that this is the environment, this is the family relationships that they've grown up in. So when we're thinking around delivering workshops and assemblies and sessions around supporting children to understand domestic abuse and healthy relationships and unhealthy relationships, it's really important that we deliver these from a trauma-informed perspective, because actually, some children and young people may be victims of domestic abuse and not recognised that they are victims in their own right. They'll recognise that they're feeling unsafe. They'll recognise that something isn't OK, but they will be flicked into safety survival mode. Their body will recognise it, but they cognitively, consciously may have not made that link. Which means that they also might be confused about why therapeutic interventions are important for them. So if we as a service have identified actually that there are victims of domestic abuse and that they need support, or we've been able to start working with this young person, and then we've found some additional information that sheds a light on actually, these are children that are affected by domestic abuse. They might start to be a little bit confused and a bit reluctant. It can also be reluctance from a parent and carer as well because they might not be at a stage that are ready to be able to acknowledge the impact domestic abuse has had on their family and their children or if they are in an abusive relationship. Now, these are some of the things that we hear from children and young people, that they don't want to blame mum and dad for what's happened to them. They never got a hit, but x, y, z have happened, that they have experienced difficulties within relationships, or they felt the need to protect the safe parent. It might have been that sometimes, that they've had good experiences with their parents and with their carers, and therefore, they're holding on to those experiences, and it's not like that all of the time. So really have to think about their experience of domestic abuse in their childhood and the narrative that has been created, and the safety, survival behaviours and their bodily response that's taking place to keep them safe. Now, feeling unsafe can make life very difficult. It can make it very difficult to engage in education, to engage and be concentrating in lessons. It might be that a young person is still supporting and caring for the safe parent, that they feel like they have a role to protect. And therefore, that can make it really difficult when you're asked to then come into school, for example, or you don't have your mobile phone available to you because of the rules that are within our school setting, that they can no longer check upon their safe parent. So it's really important that we take that into consideration, that even though they might be safe, physically safe, and the adult at home is no longer living in the household anymore, they still might have contact with them through contact rights. But also, just because you are in physically safe, it doesn't mean that you feel safe. And that feeling safe is really important for us to understand. Now, being safe as a safe parent as well, they might be frustrated with their child, that the external signs of safety now there, but it's still not enough for that young person. So that young person still might be displaying behaviours that challenge. And that become quite difficult for the safe parent. Also, trust is very difficult for parent and child. And so the same with the foster care and kinship carer. That may be also another thing that they're also dealing with. Now trust, if you think about it, is that they've had so many contacts. It might have been with external services. It might be with police. It might be with the court service, that actually, they feel like they've been let down. Or that they feel like the adult that harm is able to harm them through the systems that are supposed to be there to support them and keep them safe. So trust can be very difficult for parents and carers and also professionals coming in of the household as well. It might be that the safeguarding involved. It might be social care and education involved that actually can make that quite difficult. And previous experiences might have been that when professionals have been involved with the child or with the safe parent, that that's increased the risk of domestic abuse taking place or escalated the harmful behaviours. Now, there also is a lot of overwhelm of different emotions, and physical fears and anxieties are constant, and that's because it is a reality for them. It's very difficult for parent and child to be able to explain to a professional that there may be a certain emoji, that the adult that harm has sent to the child or to the safe parent means something very differently. So for example, it could be a smiley face, and on face value, it looks like it's a smiley face. But somebody that's experienced domestic abuse might know that actually, that smiley face means something very different. And it's us as the professionals, us as the people in a position of research, policy, and practise, to be able to think about how do we bring those nuances in, and how do we listen to the voices of the children and the safe parent in this process to help them to be able to access our early trauma-informed help. Numbing out and constant movement feels quite essential as well for children and young people as well. So it might be that you start to see that they struggle to pay attention to what their body is feeling, the emotions that they're experiencing. You might start to see that actually that children are moving around, they're rocking, it comes across that they're quite agitated. It might be that they're pacing. And it might also be that that's their response to the trauma that they've experienced. Now, if you also think about it, if you think about the relationships that these children and young people are building with us and trying to have these relationships, these therapeutic interactions with us, they might have actually been physically moved so much around. They might have been to different schools, might have been different households. They might have been couch surfing. They might have been in refuges. So we also really have to think about the physical movements that have taken place and the impact that will have on children, have been able to form relationships and foster relationships with people, but also for them to feel safe again. What does home feel like? Is that safe anymore? What does home mean for that child and for that family? So there's so much packed in how safety can feel and the factors that can contribute to feeling safe and feeling unsafe, but also being safe. So being actually safe physically as well. So we hear a lot about safe accommodation, refuges that are there for children to be able to access. But it's also as well, how do we make the house safe? So it's not that the safe parent and child is having to move out of their home. How can we help them to stay within their home, and how do we help them to feel safe again? Now, often what happens and the reason why the Healing Together Programmes were founded, it was out of a request for mums that were on their journey of healing from domestic abuse. And they recognise that their children were also victims of domestic abuse. But they couldn't access early help, early trauma-informed, domestic abuse informed help and support. They started to recognise that actually, children were starting to be labelled as challenging. They started to be labelled as children that were continuously disrupting the classroom. It's that persistent, ongoing disruptive behaviour. They didn't quite meet the threshold for national services, such as child adolescent mental health services. And therefore, it felt like it was waiting for them to become more unwell before they could access, help and support. Healing Together Programmes were founded to fill that need to enable children, young people, and families to be able to access early, trauma-informed help. In a way that didn't retraumatize them through experiencing the help and support that they needed, but also to be able to be delivered flexibly, so they can access it in their community. By people that they already know and trust and in a space that they feel safe in. So as a qualified clinical psychologist, Innovating Minds used to deliver the Healing Together Programme using our surplus resource. But quite quickly we couldn't meet demand. So by session two, we had a waiting list of 40 children that had been referred as to be able to access a Healing Together Programme. Without any kind of marketing or letting people know about referrals, the waiting list just naturally grew because people are talking about the programme, but also siblings as well. They need their own journey of healing and recovery, so we couldn't put them in the same programmes in the same group as well. So more scalable and more accessible way for us to support more children and young people affected by domestic abuse was to train frontline practitioners. Frontline practitioners that are not clinically trained but actually are working therapeutically with children and young people and families and often may be the first point of contact. It might be that they're in early health teams, family hubs, might be within schools. It might be within youth justice service. It might be within refuge. It might be domestic abuse organisations that are working in partnership with schools to deliver support. So the Healing Together Programmes are trauma-informed, and they can be delivered on a group and one to one basis, in person and online. And they're suitable for children aged five years plus. And also, we have a programme to resource parents and carers to support children affected by domestic abuse. Now, it's really important that I let you know that this isn't a parenting programme. This is a programme that supports parents and carers to understand and learn about how their body and brain are responding when they're feeling safe and unsafe and what they can do to help them to feel safe again and help them to feel regulated, so they can be there to support their child when the child is dysregulated and be a coregulator for their child. Now, the Healing Together Programme is delivered over six sessions. It's also been carefully crafted and designed to support children with special educational needs, learning difficulties, and neurodiverse needs as well. The programme includes worksheets that are inclusive of people with disabilities, different ethnicities, body shapes and sizes, hair textures. And this is really important that children feel that they can associate with the learning resources that they can identify with them, with the video animations that are within the sessions and within the worksheets. It's really important for us around accessibility. And therefore, we've translated it into Polish, Arabic, and Bengali. And hopefully, there'll be more languages as well that it's translated into. The Healing Together Programme is delivered across the UK within education, health, and social care settings, including children's residential homes as well. Within family hubs, it's becoming a part of core offers that are available to children and young people. Now, the beauty about the Healing Together Programmes is that we train frontline practitioners to be able to deliver, and we provide all of the programme resources from the manuals to the worksheets to the video animations, but also the ongoing coaching and support to the frontline practitioners, because we want to develop them to become trauma-informed practitioners and actually implement the Healing Together principles in their day to day practise. So even if they're not delivering the Healing Together Programme, they can actually deliver trauma-informed practise and principles within their work, within every interaction that they have with children and families. Now, if we think about the evidence base, now, for us, evidence based practise is built into the programme, into the process. So we use the emotional awareness questionnaire. So frontline practitioners that are delivering the Healing Together Programme complete the emotional questionnaire with the child pre- and post-intervention. They also can upload case study data as well. So the questionnaire hasn't quite captured the impact the programme is having, they can also submit case study data. And what happens is then we collate that data. We collate that data to be able to create impact reports and contribute to research, to be able to understand the impact of the Healing Together Programme. What impact is it having on frontline practitioners in terms of their ability to develop their skills. But also, how does it impact as an organisation levels. We've seen from the independent evaluation research done by Manchester Met University is actually, the programme has helped to increase retention rates. It's decreased staff absences. It's helped with recruitment because people are aware of the culture and the ethos that this organisation and this service is on. And it's also helped with connectedness between colleagues as well, that they're supporting each other. We've been able to implement the Healing Together Programme. But also thinking about quite flexibly, and creatively, how does it look in different settings like children's residential homes? We also do localised based impact reporting as well. So for example, Manchester City Council have embedded the Healing Together Programme into their early help teams. And what they've seen is actually, it's reduced children on the edge of care. It's helped them to move back home with their biological parents. They've seen that it's helped children to access education and increase attendance and increase access to learning. Now, we've also contributed to the evidence base. And the impact of the Healing Together Programme for children and young people affected by domestic abuse, has been published in the Children and Youth Services Review. Now this is an overview of the findings from the Healing Together Programme from this journal review that was taking place. Now we had a data set of 327, and that was aged from five to 16 years that had completed the healing together programme, either on a group or one to one basis. Now we use the emotional awareness questionnaire. That's as a valid and reliable questionnaire that is used for academia and to measure the impact of programmes pre and post. So what would have happened is that the children would have gone through the Healing Together Programme in different community-based settings and educational settings. And then a mix within, between ANOVA was completed. Now, what the results showed was actually, the Healing Together Programme had an impact on the child's ability to be able to differentiate between emotions, to be able to share their emotions, verbally share emotions, and not hide their emotions. So it increased their ability, have been able to develop their emotional awareness as well as interactions as well to be able to share and verbalise their emotions that they were experiencing and not hide those emotions that they were feeling. Now, there was a significant increase in those subscales and being able to increase a child's emotional awareness. And although the intervention was effective, delivered on a group and one to one basis for children aged between five and 10 and 11 to 16, we did find that the intervention did appear more effective for younger children when delivered on a one to one basis of those children aged 5 to 10 years old. Now, from a clinical point of view, that makes real sense in a sense that actually, if we can support children, access early help and early intervention, support their development around their emotional intelligence and helping them to be able to understand how their body and brain are working together and what happens when they're feeling safe and unsafe. Actually, if we can deliver that earlier on, then the benefits is going to be significantly enhanced. Now, that's not to say that children aged 11 to 16 didn't find the programme effective. We're just saying that it appeared more effective for children aged five to 10 and delivered on a one to one basis. So in conclusion, we actually found that Healing Together Programme was effective in increasing children's emotional awareness. And we particularly feel that this is due to the trauma informed approach that is embedded throughout the programme, allowing for safety and security and co-regulation to take place. Children that have completed the programme talk about how they've enjoyed that interaction with the facilitator, how they've felt safe, how they've not been felt pressured to talk about it and open up. It's not been about reliving their experience of trauma or experience of domestic abuse. It's actually been around helping them to learn how their body and brain works together, what happens when they're feeling safe and unsafe. What are their sensory experiences, that might be different sensors that they like and don't like. But also then been able to think about a plan, strategies that they can use, that they feel comfortable with, body-based strategies. And understanding how breathing techniques work and the impact that has on them. We continuously contribute to research as well. So do look out for more research that's been published as well, as well as on our website and in journal articles. Now, it's also important to look at the impact beyond numbers. Questionnaires don't quite capture other stories as well that we're seeing around the impact of the healing together programme. We've seen that the programme has helped to reduce child to parent violence. It's helped child and parent reconnect as well. It's helped that the relationship between the child and parent has become stronger. The parent is able to understand and support the child when they're feeling unsafe, and it's presenting as challenging behaviour. They're able to look at it from a different lens and find ways to be able to offer co-regulation and help them to feel safe and regulated again. We've also seen that it's provided a positive help so you can experience, for the child and for the wider family as well, to point that we've had families reach out to their practitioner to say, do you have anything else that's available? Because they've seen the impact, and it's helped them to build a relationship with the practitioner in a way that's been positive and that they've seen the benefits of it. We've seen increase in education engagement, and attainment, and school attendance. We've had children where they've actually had really, really poor attendance. And whilst they've been accessing the Healing Together Programme and after the Healing Together Programme, they've come into school every day. Not just for the day that the Healing Together Programme is taking place but every day for six weeks and beyond the programme as well. Which is huge for children to be able to come in and feel that they're able to feel safe in school and be able to engage in their sessions, in their lessons. But also, we've had children that have shared their tools and strategies with the wider class and helped and coached their peers to use the strategies that they've learnt in the healing together programme. We've heard from children that are still using the skills two years on, that we've been able to access further help and support children that are on the risk, on the edge of care, or children that are in care, that they've been through the Healing Together Programme. Children's residential home have adopted it as their way of being, and it's helped them to move out of care and move back home with their biological parents as well. So the impact has been incredible. Now, how you measure impact is always really important because of the evidence-based practise. But it's also really important to hold on to those individual stories that we come across and that frontline practitioners experience. So in summary, to bring this together, it's really important that we recognise babies, children, and young people as victims of domestic abuse in their own right and really remember that the impact of domestic abuse is stored in our sensory memory, stored in our nervous system. So asking children to talk about their experiences and cognitively process their experience of domestic abuse actually retraumatizes them, as opposed to processing the trauma that they've experienced. So it's really important that we look to commission trauma-informed based interventions that are not focused on children having to relive their experiences. And really focused on commissioning and using interventions that can be delivered flexibly, whether it's a group or one to one basis. It can be delivered in short bursts. It can be delivered in the community. It can be delivered online. It can be delivered within education and social care settings. Also, what we found is that the healing together programme is an evidence based programme to support children and families that are affected by domestic abuse, and the research around that has been published in the journal article demonstrates the programme is suitable for children aged five years plus. And the impact around supporting children to be able to verbally share their emotions, to be able to differentiate between their emotions and not hide emotions, have been shown to be proven to support children to be able to actually start their journey of healing and recovery. Now, thank you so much for joining me today. I really appreciate your interest and engagement. If you would like to know more about embedding trauma-informed practise within your services, it might be that you're interested in how to embed trauma-informed programmes to support children and young people affected by domestic abuse. Please do reach out. We're always here to support our organisations, services, and practitioners, and academics as well that are interested in supporting children and young people affected by domestic abuse. Thank you.